Accurately Identifying Adolescents Who Will Exhibit Persistent Frequent Substance Use in Adulthood: The Importance of Replicating Findings Across Studies

Introduction: Substance abuse accounts for a substantial portion of the global disease burden, and in the United States, substance abuse costs over $700 billion annually in health care, lost work productivity, and crime. Consequently, there is great interest in prevention. Research suggests that adolescence (~ ages 12-18) is a critical period for prevention and early intervention, but the field lacks effective strategies for identifying at-risk youth for indicated prevention and early intervention. More work is needed to develop tools that accurately predict an adolescent’s long-term risk for problematic substance use. We leverage prospective, longitudinal data to inform the development of such a tool.

Methods: We report on the accuracy with which adolescent risk factors from a previously validated screen predict persistent frequent substance use in adulthood. Data come from the Pittsburgh Youth Study. Boys (n=503) were followed from approximately age 7 to age 28. Risk factors were assessed yearly from age 7 to age 18 and included demographic factors, psychiatric risk, adolescent substance use, and family history of substance use problems. The outcome was persistent frequent substance use in adulthood (ages 25 and 28).

Results: We assess the predictive accuracy of each risk factor at various ages and compare the predictive accuracy of various risk models for youth of different ages.

Conclusions: We illustrate how prospective, longitudinal data can be used to inform the development of risk assessment tool that accurately predicts which adolescents will engage in persistent frequent substance use though young adulthood. We discuss challenges associated with translation to real-world practice.